围绝经期异常子宫出血200例的临床与病理分析

Clinical and pathological analysis of 200 cases of perimenopausal abnormal uterine bleeding

目的探讨围绝经期异常子宫出血的发病原因及病理变化。方法对200例39—55岁围绝经期异常子宫出血患者的临床及病理资料进行回顾性分析，总结不同年龄组病理类型分布特点，分析各种病理类型的临床相关因素。结果200例患者中，功能失调性子宫出血占74．5％，其中39～45岁占56．2％；子宫内膜不典型增生占7．5％，其中51—55岁占40％；子宫内膜癌占5．0％，其中51。55岁占60．0％；其他良性病变占13％。患者的年龄、出血时间、高危因素与子宫内膜病理分型存在关联性（，值分别为37．32、2118．45、10．04，均P〈0．01）。结论功能失调性子宫出血是围绝经期39～50岁年龄阶段异常子宫出血的主要原因，但51～55岁年龄阶段在子宫内膜不典型增生及子宫内膜癌发病比例较高。存在高危因素的围绝经期异常子宫出血妇女其发生子宫内膜癌的危险性明显高于无高危因素的患者，随着年龄增大、出血时间延长，子宫内膜癌发病危险性增加。

Objective To explore the causes and pathological changes of perimenopausal abnormal uterine bleeding. Methods Retrospective analysis was conducted to analyze the clinical and pathological data of 200 cases aged 39-55 years old with perimenopausal abnormal uterine bleeding. Distribution characteristics of pathological types of different age group were summarized and clinical related factors of each pathological type were analyzed. Results In 200 patients, patients with dysfunctional uterine bleeding occupied 74.5%, among whom 56.2% were patients aged 3945 years old. Patients with endometrial atypical hyperplasia occupied 7.5%, and those aged 51-55 years old accounted for 40%. Patients with endometrial carcinoma accounted 5.0%, among whom 60.0% were aged 51-55 years old. Other benign lesions accounted for 13%. Age, bleeding time and risk factors were correlated with endometrial pathological type （X2 value was 37.32, 2 118.45 and 10. 04, respectively, all P 〈 0.01 ）. Conclusion Dysfunctional uterine bleeding is the major cause of uterine abnormal bleeding among perimenopausal patients aged 39-50 years old, but the incidence of endometrial atypical hyperplasia and endometrial cancers among patients aged 51-55 years old is relatively high. Patients of perimenopausal abnormal uterine bleeding with high risk factors suffer higher risk of endometrial cancer than those without high risk factors. With the increasing of age and prolonging of bleeding, the risk of endometrial cancer increases.